Transcript Document

19
Caring for Muscle and Bone Injuries
Objectives
1.Define the following terms:
a.Anatomical position
b.Angulated
c.Blunt trauma
d.Closed fracture
e.Cravat
f.Dislocation
g.Manual stabilization
(continued)
Objectives
1.Define the following terms:
h.Open fracture
i. Position of function
j.Sling
k.Splint
l. Sprain
m.Strain
n.Swathe
(continued)
Objectives
2.Describe the components that make
up the musculoskeletal system.
3.Explain the functions of the
musculoskeletal system.
4.Describe the major bones of the
skeletal system.
5.Describe the signs and symptoms of
a musculoskeletal injury.
(continued)
6.Differentiate between a strain,
sprain, fracture, and dislocation.
Objectives
7.Differentiate between an open and
closed skeletal injury.
8.Explain the appropriate care for a
patient with a skeletal injury.
9.Explain the importance of an
appropriate assessment of the distal
extremity.
10.Differentiate between direct and
indirect forces and the injuries they
(continued)
cause.
Objectives
11.Explain the criteria for placing an
angulated extremity injury into an
anatomical position.
12.Explain the purpose and methods
for manual stabilization of a skeletal
injury.
13.Explain the priority of care for a
patient with a suspected open
skeletal injury.
(continued)
14.Explain the priority of care for
Objectives
15.Demonstrate the appropriate
assessment of a skeletal injury.
16.Demonstrate the appropriate care
for a patient with a long-bone
injury.
17.Demonstrate the appropriate care
for a patient with a joint injury.
18.Demonstrate the appropriate
technique for manual stabilization(continued)
of a skeletal injury.
Objectives
19.Demonstrate the proper placement
of an angulated extremity injury
into an anatomical position.
20.Demonstrate the proper placement
of an arm sling.
21.Demonstrate the ability to place the
hand/foot in the position of function
during immobilization of an
extremity.
22.Value the importance of proper
Topics
•
•
•
•
Musculoskeletal System
Appendicular Skeleton
Splinting
Management of Specific Extremity
Injuries
MUSCULOSKELETAL SYSTEM
Musculoskeletal System
• Musculoskeletal System
– Made up of muscles, bones, joints,
connective tissues, blood vessels, and
nerves.
• EMR's job is to carefully assess
patient, looking for signs and
symptoms of injury (pain, swelling,
deformity, discoloration).
Musculoskeletal System
• Four Major Functions
– Support
– Movement
– Protection
– Cell Reproduction
• Skeletal System Major Divisions
– Axial skeleton
– Appendicular skeleton
Anatomy of the extremities.
(A = artery. N = nerve. V =
vein.)
appendicular skeleton
(shown in the first figure in
yellow) and the axial
skeleton (shown in the
second figure in yellow).
Think About It
• What does it mean to use an
assessment-based approach?
• What is the EMR's primary job in
dealing with musculoskeletal
injuries?
• What can happen when blood vessels
and nerves are injured?
APPENDICULAR SKELETON
Appendicular Skeleton
• Made up of bones that form upper
and lower extremities.
• Upper extremities made up of
shoulder girdle and both arms, down
to and including fingers.
Bones of the Upper
Extremities.
Bones of the upper
extremities.
Appendicular Skeleton
• Lower extremities made up of pelvis
and both legs, down to and including
toes.
Bones of the Lower
Extremities.
Bones of the lower
extremities.
Appendicular Skeleton
• Causes of Extremity Injuries
– Direct force: applied to bone when
person falls and strikes object or when
person is struck by object.
– Indirect force: energy of a force
transferred up or down extremity;
results in injury farther along extremity.
(continued)
Appendicular Skeleton
• Causes of Extremity Injuries
– Twisting force: when someone gets
hand or foot caught in wheel or gear.
• Closed injury
– No break in skin.
• Open injury
– Soft tissues adjacent to injury damaged
and open.
Select Mechanisms of
Extremity Injury
Closed and open injuries.
Appendicular Skeleton
• Do not try to diagnose injury.
• Fracture
– Any time bone is broken, chipped,
cracked, or splintered.
• Dislocation
– One end of a bone that is part of a joint
is pulled or pushed out of place.
Appendicular Skeleton
• Sprain
– Excessive twisting forces cause
ligaments and tendons to stretch or
tear.
• Strain
– Caused by overexerting, overworking,
overstretching, or tearing of a muscle.
• Angulated (deformed) injuries
– Extremity is bulging, bent, or angulated
where it normally should be straight.
Appendicular Skeleton
• Signs-Symptoms of Extremity
Injuries
– Pain
– Swelling
– Discoloration
– Deformity
– Inability to move a joint or limb
– Numbness or tingling sensation
– Loss of distal pulse
(continued)
Appendicular Skeleton
• Signs-Symptoms of Extremity
Injuries
– Slow capillary refill
– Grating
– Sound of breaking at time of injury
– Exposed bone
(continued)
Appendicular Skeleton
• Signs-Symptoms of Extremity
Injuries
– All injured extremities should be
assessed for adequate circulation,
sensation, motor function (CSM) before
and after immobilization.
– If injury site is swollen and discolored,
there is bleeding in tissues.
(continued)
Appendicular Skeleton
• Signs-Symptoms of Extremity
Injuries
– If no distal pulse and extremity is pale
and cool, circulation to extremity may
be compromised.
– If extremity is blue, there is lack of
circulation and lack of oxygen in limb.
(continued)
Assessing capillary refill in
the fingers. (©Dan Limmer)
Appendicular Skeleton
• Patient Assessment
– Scene size-up: scene safety; BSI
precautions; don PPE; note MOI; total
number of patients.
– Primary assessment: impression of
environment and patient; determine if
patient needs to be moved and
transported; assess ABCs and mental
status; detect life-threatening problems.
(continued)
Appendicular Skeleton
• Patient Assessment
– When caring for skeletal injuries, first
priority is given to injury of spine.
•
•
•
•
•
Skull
Rib cage
Pelvis
Thighs
Any extremity
Algorithm for emergency
care of patients with
musculoskeletal injuries.
Appendicular Skeleton
• Emergency Care Steps
– Take proper BSI precautions; perform
primary assessment.
– Cut away clothing to expose injury site.
– Control bleeding if there is open wound.
– Check for distal circulation, sensation,
and motor function in affected
extremity.
– Immobilize extremity using manual
(continued)
stabilization or splints.
Appendicular Skeleton
• Emergency Care Steps
– Apply cold pack or ice pack to injury site
to help reduce pain and swelling.
– Administer oxygen per local protocol.
– Assess patient's vital signs.
– Emotional support important when
caring for patient with musculoskeletal
injuries.
Think About It
• You are treating a young woman who
has been struck by a car. She has an
angulated lower leg fracture. You ask
her if her neck or back hurts and she
says “No.”
• How reliable is this answer?
• How will you proceed?
SPLINTING
Splinting
• Splinting
– Immobilizing injury, using device (piece
of wood, cardboard, folded blanket);
any object that can be used to restrict
movement of injury.
• Manual stabilization
– Using your hands to restrict movement
of injured person or body part.
Splinting
• Application of splints allows
reposition and transfer of patients
while minimizing movement of injury.
• Complications resulting from
splinting include:
– Pain
– Damage to soft-tissues
– Bleeding
– Restricted blood flow
– Closed injuries become open injuries
Splinting
• Emergency Medical Responder
Responsibilities
– Detect and control life-threatening
problems.
– Attempt to find all injuries and care for
worst ones first.
Splinting
• General Rules for Splinting
– Assess and reassure patient.
– Expose injury site.
– Control all major bleeding.
– Dress open wounds.
– Check distal circulation, sensation, and
motor function before and after
splinting.
– Splint injuries before moving patient.
(continued)
Splinting
• General Rules for Splinting
– Have materials ready before splinting.
– If distal circulation is absent and local
protocols allow, gently attempt to
realign an angulated limb in anatomical
position before splinting.
– Immobilize suspected fracture site and
joints above and below injury site.
(continued)
Splinting
• General Rules for Splinting
– Secure splints with cravats or roller
gauze.
– Elevate extremity.
– Minimize effects of shock by maintaining
body temperature and providing oxygen
per local protocols.
Manual stabilization of an
injured limb.
Splinting
• Managing Angulated Injuries
– Do only what you have been trained to
do and what is allowed in your EMS
system.
– If no distal pulse, and skin in distal
extremity is pale or blue and cold, take
action immediately to minimize potential
permanent damage.
(continued)
Splinting
• Managing Angulated Injuries
– Do not force limb if you meet resistance
or if patient complains of too much pain.
– Apply soft splint and elevate limb by
propping it on blanket roll or pillow.
– Provide oxygen (if allowed).
Splinting
• Types of Splints
– Soft splints: pillows, blankets, towels,
cravats, dressings, triangle bandage,
sling, swathe.
(continued)
the triangular bandage over
the uninjured shoulder.
Ensure that the apex is
pointed toward the injured
arm.
bandage up and over the
shoulder on the injured
side. Tie a knot at the side
of the neck.
Pin or tape the apex to form
a pocket at the elbow.
Secure the arm to the body
with a swathe.
Splinting
• Types of Splints
– Rigid splints: plastic, metal, wood, or
compressed cardboard; very little give
or flexibility.
(continued)
Splinting
• Types of Splints
– Commercial splints: made of wood,
aluminum, cardboard, foam, wire, or
plastic.
– Pneumatic antishock garment (PASG):
special device for splinting suspected
pelvic and femur fractures. Check local
protocol.
(continued)
Splinting
• Types of Splints
– Inflatable splints (air splints): used for
patients with injuries to arm or lower
leg bones.
(continued)
and slide it over the
Warning:
Air splints may leak.
When applied in cold weather,
an air splint
patient's
extremity.
Allow
will expand when the patient is moved to a warmer place. Pressure also will
change at different altitudes. Monitor the pressure in the splint by pressing
the
orto thetoes
to
with your
fingertip.fingers
These splints may stick
patient's skin
in hot
weather.
remain exposed at the end
of the splint.
extremity while your
partner inflates the splint.
Inflate so that you leave a
slight dent when the splint
is pressed with one finger.
sensation, and motor
function, and monitor the
pressure of the splint. Add
air if necessary.
Splinting
• Types of Splints
– Improvised splints may be soft or rigid;
made from variety of materials.
Think About It
• You are treating a patient with a
broken femur following a motorvehicle crash. Before you apply a
traction splint, what other
assessment elements should you
consider?
• Why might taking the time to apply a
traction splint in this situation be illadvised?
MANAGEMENT OF SPECIFIC
EXTREMITY INJURIES
Algorithm for the
assessment and emergency
care of patients with
extremity injuries.
Management of Specific
Extremity Injuries
• Apply rigid splints for injuries to
forearm and lower leg.
• Use soft or rigid splints for injuries to
arm, elbow, wrist, or hand.
• Use soft splints for injuries to ankle
or foot.